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Hemorrhoids

Chen Shigong stated: Hemorrhoids arise from a pre-existing condition of damp-heat in the body, excessive consumption of roasted or grilled foods, or prolonged sitting leading to stagnant blood circulation. They can also result from emotional disturbances (Seven Emotions), excessive intake of raw and cold foods, carrying heavy loads, or strenuous long-distance travel, causing chaotic Qi and blood and interlaced meridians. Additionally, excessive indulgence in alcohol and sexual activity damages the intestines and stomach, allowing turbid Qi and stasis to flow into the anus. Women may also develop this condition due to excessive exertion during childbirth, causing blood to reverse into the anus. Initially presenting as hemorrhoids, if left untreated for a long time, they evolve into fistulas (Zhenzong).

Chen Yuan Gong stated: Red nodules suddenly appear inside, outside, and around the anus, starting with itching followed by pain, eventually forming hemorrhoids. Chronic non-healing cases are caused by damp-heat. This is most common among those who indulge in drinking; people in Jiangnan frequently suffer from it due to local damp-heat combined with the toxicity of alcohol heat, which accumulates in the anus and cannot dissipate quickly. The anus connects to the large intestine; damp-heat should normally exit with stool. Why does it accumulate? Dampness cannot stay long in the large intestine but flows entirely toward the anus. The anus acts as the lock and key of the large intestine, preventing damp-heat from escaping freely. Thus, after long accumulation, the toxic damp-heat is borne solely by the anus. Toxicity must manifest externally, not internally within the anus, so it appears on the outside. Though internal and external presentations differ slightly, the suffering is the same. How can treatment ignore damp-heat? However, the anus is far from the Spleen and Stomach. Resolving damp-heat toxicity requires passing through the Spleen and Stomach; if the anus benefits little while the Spleen and Stomach are damaged first, treatment fails. Therefore, medicines must not harm the Spleen and Stomach but benefit the anus to be effective. Yihou Tang treats this: Bai Shao (White Peony Root), Fu Ling (Poria), Shan Yao (Chinese Yam), Yi Ren (Coix Seed) each 1 liang, Di Yu (Sanguisorba Root) 3 qian, Chuan Shan Jia (Pangolin Scale) 1 slice (soil-fried), decocted in water and taken orally. After four doses, the anus feels relaxed; after another four doses, internal and external hemorrhoids disappear. Then, make pills ten times the dose with honey, taking 5 qian daily with warm water. One course prevents recurrence (Bingjian). This formula promotes urination and removes dampness, benefiting both the Spleen and the anus without harming them.

He further stated: A small boil may appear at the edge of the anus. If one does not abstain from alcohol and sex, it rots and becomes a hemorrhoidal fistula that cannot close, forming a flesh tube. Each year, a tube forms, discharging pus and blood, causing great suffering. People often treat this with knives, needles, and hanging threads, enduring pain while internal toxins remain, making external healing difficult over years. Are fistulas incurable, or must one abstain from alcohol and sex? It is merely improper treatment. Anal tissue differs from other parts; its muscles run both longitudinally and transversely, making healing hardest. Frequent bowel movements plus knife/needle/thread treatments cause repeated injury, hindering rapid tissue growth. Thus, avoid knives and threads lightly. Internal treatment to eliminate damp-heat toxicity is best. However, for chronic fistulas, even if bleeding stops, Qi and Blood are damaged, making efficacy low. Treatment should combine tonification with elimination. Qing Gui Wan: One turtle, Fu Ling 5 liang, Huang Bo (Phellodendron Bark) 8 liang, Dang Gui (Angelica Sinensis) 3 liang, Ren Shen (Ginseng) 2 liang, Yi Ren 6 qian, Chuan Shan Jia 5 qian (soil-fried), Wa Song (Cladonia) 2 strips (air-dried, no fire), Bai Zhi (Angelica Dahurica), Huai Mi (Sophora Flower), Gan Qing Tai (Dry Moss) each 1 liang, four sheep hind hooves (soil-fried). Pound the turtle in a stone mortar, mix with powder, steam in a rice cooker. Dry the meat and shell, grind to powder, mix with previous powders, form honey pills. Take 3 qian daily. In one month, the fistula dries; in two months, it fills. Complete cure follows. Abstain from alcohol and sex for three months during treatment; otherwise, it fails. This formula is miraculous for fistulas, removing dampness without dispersing Qi, defeating toxins without damaging Blood, repairing invisibly, and filling holes effectively.

He also stated: Some patients spray a little blood before defecation. Laypeople think it is hematochezia, but it is actually hidden blood hemorrhoids. Long-standing hemorrhoids become fistulas discharging pus and blood. However, different causes yield different symptoms. This case often results from excessive strong wine, where heat travels to the rectum but cannot vent quickly, forming small hemorrhoids. Later, skin breaks, and blood exits from outside the rectum, specifically from the Bladder. The Bladder transforms Qi, not Blood. Wine toxin enters the Bladder; wine-Qi turns to water and exits via the genitalia, but wine-toxin scorched blood cannot exit there nor flow to the large intestine/anus. With blocked pathways, wine-toxin accumulates outside the rectum, attacking inward, generating rectal hemorrhoids. Once broken, the Bladder's blood flows in. Over time, blood attracts blood, and during defecation, blood bursts out. Treatment must urgently fill the gap to block blood exit. However, since the channel is open, simply blocking the lower outlet is insufficient. One must clear the upper source. Qingyuan San: Huang Lian (Coptis), Huai Hua (Sophora Flower), Di Yu, Ren Shen each 3 qian, Fu Ling, Bai Zhu (Atractylodes Macrocephala) each 5 qian, Che Qian Zi (Plantago Seed), Ge Gen (Kudzu Root) each 3 qian, Bai Zhi 3 fen, Chuan Shan Jia 1 qian (soil-fried), all ground. Mix with San Qi (Notoginseng) powder 3 qian. Decoct and take with powder. After three doses, bleeding increases; remove Huang Lian. After three more doses, bleeding stops and hemorrhoids heal. Must abstain from alcohol lifelong. For sexual abstinence, three months suffices to prevent recurrence. If unable to abstain, do not use my formula. This formula uses much Huang Lian to resolve wine-heat toxicity, clearing the source. If the source is healthy, the flow is safe.

Jiang Shiji stated: Hemorrhoids vary in type: Milk Hemorrhoid, Chicken Heart Hemorrhoid, Chicken Comb Hemorrhoid, Water Chestnut Hemorrhoid, Lotus Hemorrhoid, Pearl Hemorrhoid, Coral Hemorrhoid, Honeycomb Hemorrhoid, Chicken Liver Hemorrhoid, Fan-flower Hemorrhoid, Intestinal-Piercing Hemorrhoid, Rat Milk Hemorrhoid, Cherry Hemorrhoid, Rat Tail Hemorrhoid, Walnut Hemorrhoid, Clam Meat Hemorrhoid, Internal Hemorrhoid, External Hemorrhoid. Names are based on shape. Causes include post-coital indulgence, rich food and alcohol, carrying heavy loads, leading to damp-wind-heat-dryness, turbid Qi, and stasis flowing to the anus. Postpartum women with excessive exertion and blood stasis also get this. Mild toxicity has normal shapes; deep toxicity has abnormal, stubborn shapes. Long-term leads to fistulas; new onset causes heaviness and stabbing pain. Severe cases have feces exiting pores and blood flowing from orifices. Qi and Blood decline daily. Treatment focuses on cooling Blood and moving Qi. External treatment distinguishes internal and external: Internal hemorrhoids treated with "Awakening" and "Withering" methods; painful external hemorrhoids cleared; large-head/small-stalk ones ligated; small-head/large-base ones withered (Shuoyue).

He further stated: Sores that do not heal for a long time discharge pus daily. Doctors inserting paper wicks cause friction, forming pus tubes like rush stems, named Fistula Syndrome. This is due to Qi and Blood deficiency and heat-toxin stagnation disrupting Ying and Wei circulation. It occurs in weak areas of the body, especially easily in hemorrhoidal fistulas. Knife/thread treatments cause pain; internal dissolution with Tuche Ke San is better. Tonify with Shiquan Dabu Tang and Buzhong Yiqi Tang.

Feng Luzhan stated: Five names for hemorrhoids/fistulas: Male (Mu), Female (Pin), Qi, Blood, Wine. Also Intestinal Wind Hemorrhoid, Pulse Hemorrhoid, Yin-Yang Hemorrhoid are aliases. Initial stage: lumps near anus like rat milk or small nodes, itchy/painful/distended. Severe cases have fever/chills. Causes: sexual fatigue, alcohol excess, sweet/greasy diet, drunkenness. These damage Yin-Yang and vessels, causing intestinal leakage to the lower body. Early treatment: Qin Jiao, Huai Jiao, Lian Qiao, Tu Bei Mu. External fumigation/washing for internal resolution. If desires continue, rotting/pus/blood occur, penetrating orifices to become fistulas. Must tonify Qi/Blood and regulate lifestyle gradually.

He also stated: Hemorrhoids are sores/swelling/pain near the anus. Fistulas have sores with holes, weeping fluid. Causes: maternal diet of alcohol/noodles/roasted food in utero, or postnatal imbalance causing Heart Heat transmitting to Lung, then Large Intestine. Pediatric hemorrhoids: internal cooling Blood/detoxifying, external fumigation/washing.

He further stated: Origin of hemorrhoids/fistulas: Pathogenic factor is Dryness; Disease manifestation is Damp-Heat. Caused by alcohol/sex excess, dampness generating heat, filling organs/meridians, dropping to the anal region, conflicting to form hemorrhoids. Though appearing in Large Intestine, it is actually Yin Deficiency with Fire Excess. Orifices open to the two yin; long-term ulceration becomes fistula. Hemorrhoids are mild/solid; Fistulas are severe/deficient. Treat hemorrhoids by cooling Blood/clearing Heat. Treat fistulas initially by cooling Blood/clearing Heat/drying Dampness; later by astringing orifices/killing parasites/warming dispersing. Some say Fire is the root, why use drying/astringent? Hemorrhoids bleed (always Heat); Fistulas discharge pus (initially Damp-Heat, finally Damp-Cold). Without warming herbs, how to dispel Cold? Many diseases start Hot and end Cold (e.g., diarrhea/vomiting starts Intestine/Stomach Excess-Heat, ends Deficiency-Cold). Danxi noted: Chronic bleeding treated later with warming agents confirms this.

Zhu Danxi stated: Fistulas require initial tonification to generate Qi/Blood using large doses of Ren Shen, Bai Zhu, [missing], Dang Gui. Then apply Moxibustion with Aconite cakes (Aconite powder mixed with saliva, coin-thick). Large fistula/large moxa cone; small fistula/small cone. Moxa until slightly warm, not painful. Replace when dry. Stop if tired, resume next day until flesh levels. Alternatively, use Aconite slices with tonic paste.

Li Dongyuan stated: Intestinal mass = Dampness; Severe pain = Wind; Dry stool = Fire-Heat. Four pathogens (Damp, Heat, Wind, Dryness) combine. Treatment: Purge Fire, moisten Dryness, soothe Wind, harmonize Blood, stop pain.

Feng Luzhan stated: Early hemorrhoids/fistulas: Huang Qin, Huang Lian to cool Large Intestine; Zhi Qiao to widen Large Intestine. Astringent orifices: Chi Shi Zhi, Bai Shi Zhi, Ku Fan, Huang Dan, Bing Pian.

He also stated: To cure hemorrhoids/fistulas, taste the flavorless, do the effortless. Careful regulation ensures recovery; negligence makes treatment futile.

Dou Hanqing stated: Main treatment cools Blood. If an extra orifice near anus discharges pus/blood, it is Single Fistula. Treat internally with warming tonics, externally with flesh-generating ointments.

Dou Menglin stated: Orifices in skin heal easily; those from organ damage are hard to treat.

Yangsheng Bixiao Fang recorded: Monk Jiehai had hemorrhoids despite high moral conduct, caused by overeating and sitting too long. *Suwen* states: Overeating relaxes sinews/vessels, causing intestinal hemorrhoids. Sanshen Wan treats monk/Daoist hemorrhoids differently.

Qi Tian Shi stated: A snake-like protrusion from the anus, entering/exiting, painless during defecation, is extreme Large Intestine Damp-Heat creating flesh (not snake) in the rectum. Treat with Zhuxie Sheshedan internally. Externally wash with 1 liang Good Black Fungus decoction. Apply Bing Pian powder after washing. Shrinks and heals miraculously.

Cheng stated: For hemorrhoids/fistulas/Guan Kou lesions where sitting is impossible, use a thick reed-flower cushion with a central hole. Sit with the lesion in the hole to avoid pressure injury.